早期肠内营养对急性重症胰腺炎炎症介质及营养指标的影响

The effects of early enteral nutrition on inflammatory mediators and nutrition indicators in severe acute pancreatitis

目的探讨早期肠内营养对急性重症胰腺炎患者炎症介质、营养指标及临床恢复的影响。方法 2006年1月至2010年3月收治的急性重症胰腺炎患者患者59例,随机分成早期肠内营养组31例,肠外营养组28例,观察上述两组治疗后1、3、7天血清中TNF-α、IL-1β、前白蛋白、清蛋白的水平;外周血淋巴细胞数;并观察两组血清淀粉酶恢复时间,全身炎性反应综合征(Systemic infammactery response syndrome,SIRS)、腹腔脓肿及肝功能异常例数,治疗费用等指标的差异。结果早期肠内营养组治疗后3、7天血清TN F-α、IL-1β浓度明显低于肠外营养组(P<0.05),前白蛋白、清蛋白的水平、外周血淋巴细胞数明显高于肠外营养组(P<0.05),治疗费用低于肠外营养组(P<0.05),两组血清淀粉酶恢复时间,SIRS、腹腔脓肿及肝功能异常例数无明显差异(P>0.05)。结论早期肠内营养在改善急性重症胰腺炎患者营养状态方面明显优于肠外营养,有利于提高机体的抗感染能力和各系统机能的恢复,是可靠、安全、经济的营养支持手段。

Objective To investigate the effects of early enteral nutrition on inflammatory mediators , nutritional indicators and clinical recovery in patients with severe acute pancreatitis .Method 59 patients with severe acute pancreatitis admitted to the hospital from January ,2006 to March,2010 were randomly divided into two groups .31 cases were chosen as the early enteral nutrition group and 28 cases were chosen as the parenteral nutrition group .Differences of Serum TN F-α, IL-1β, prealbumin, albumin levels after 1,3,7 days treatment were observed and peripheral blood lymphocytes , recovery time of serum AMY, patient cases of SIRS, abdominal abscess and liver dysfunction , and treatment costs in both groups were recorded.Findings Findings serum TN F-α, IL-1βconcentration after 3, 7 days treatment in early enteral nutrition group was significantly lower than those of the parenteral nutrition group （P 〈0.05）.prealbumin, albumin level, and thenumber of peripheral blood lymphocytes was significantly higher than those of the parenteral nutrition group （P 〈0.05）.The treatment costs was less than that of the parenteral nutrition group （P 〈0.05）.The recovery time of serum AMY,cases of SIRS , abdominal abscess, and liver function abnormalities were not significant （P 〉0.05）.Conclusion Earlyenteral nutrition in improving the nutritional status of patients with severe acute pancreatitis was superior to parenteralnutrition.It can help to improve the body’s resistance to infection and functional recovery .Therefore, it can serve as a safeand economical means of nutritional support way .